Submandibular space infection: a potentially lethal infection.
OBJECTIVE
The aims of this study were to review the clinical characteristics and management of submandibular space infections and to identify the predisposing factors of life-threatening complications.


METHODS
This was a retrospective study at a tertiary academic center. We retrieved and evaluated the records of all patients admitted to the University of Padua Otolaryngology Clinic at Treviso Regional Hospital with the diagnosis of submandibular space infection for the period 1998-2006. The following variables were reviewed: demographic data, pathogenesis, clinical presentation, associated systemic diseases, bacteriology, imaging studies, medical and surgical treatment, and complications. A multivariate logistic regression analysis was undertaken using a forward stepwise technique.


RESULTS
Multivariate analysis identified four risk factors for complications. Anterior visceral space involvement (odds ratio (OR) 54.44; 95% confidence interval (CI) 5.80-511.22) and diabetes mellitus (OR 17.46; 95% CI 2.10-145.29) were the most important predictive factors in the model. Logistic regression analysis also confirmed other comorbidities (OR 11.66; 95% CI 1.35-100.10) and bilateral submandibular swelling (OR 10.67; 95% CI 2.73-41.75) as independent predictors for life-threatening complications.


CONCLUSIONS
Airway obstruction and spread of the infection to the mediastinum are the most troublesome complications of submandibular space infections. Therefore, the maintenance of a secure airway is paramount. Patients with cellulitis and small abscesses can respond to antibiotics alone. Surgical drainage should be performed in patients with larger abscesses, Ludwig's angina, anterior visceral space involvement, and in those who do not respond to antibiotic treatment. Moreover, the clinical assessment in patients with comorbidities, especially diabetes mellitus, requires a high level of suspicion for potential life-threatening complications. Early surgical drainage should always be considered in these patients, even in seemingly less critical cases.
Boscolo-Rizzo
Paolo
P
Department of Medical and Surgical Specialities, Otolaryngology Clinic - Regional Center for Head and Neck Cancer, University of Padua, School of Medicine, Treviso Regional Hospital, Treviso, Italy. paolo.boscolorizzo@unipd.it
Da Mosto
Maria Cristina
MC
D000038:Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D002648:Child; D015331:Cohort Studies; D004322:Drainage; D005260:Female; D006801:Humans; D008158:Ludwig's Angina / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010309:Parotitis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D010612:Pharyngitis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D055815:Young Adult
D000900:Anti-Bacterial Agents